Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Int J Tuberc Lung Dis. 2012 Oct;16(10):1300-6. doi: 10.5588/ijtld.12.0004. Epub 2012 Aug 3.
Diagnosis of latent tuberculosis infection (LTBI) before anti-tumour-necrosis factor (anti-TNF) treatment is important. However, the tuberculin skin test (TST) has limitations, and the role of interferon-gamma release assays has not yet been determined.
To evaluate the combined use of TST and the T-SPOT(®).TB (T-SPOT) assay prior to anti-TNF treatment.
From July 2004 to March 2008, 281 patients were treated with anti-TNF agents. TST and T-SPOT were performed simultaneously at baseline. LTBI was defined as a positive TST of ≥10 mm induration or as a positive T-SPOT if TST was ≥5 mm but <10 mm. LTBI treatment was initiated, and patients were followed until August 2010.
Positivity rates for TST and T-SPOT were respectively 33.6% (94/280) and 69.1% (186/269). LTBI treatment was initiated in 35.9% (101/281) of the patients, and active TB developed in 2.1% (6/281). Among the six TB patients, three were TST-negative at baseline and received no LTBI treatment, whereas all four who underwent T-SPOT showed positive results at baseline.
In a TB-prevalent country, TST-defined LTBI diagnosis and treatment seem to be limited in preventing the development of TB before anti-TNF treatment. Further studies for T-SPOT alone or the combined use of TST and T-SPOT (either test positive strategy) for detecting LTBI are necessary.
在使用抗肿瘤坏死因子（anti-TNF）治疗之前，诊断潜伏性结核感染（LTBI）很重要。然而，结核菌素皮肤试验（TST）有其局限性，干扰素 - γ释放试验（IGRA）的作用尚未确定。
评估 TST 和 T-SPOT(®).TB（T-SPOT）检测联合应用于抗 TNF 治疗前。
2004 年 7 月至 2008 年 3 月，281 例患者接受抗 TNF 药物治疗。基线时同时进行 TST 和 T-SPOT 检测。LTBI 的定义为硬结≥10mm 的 TST 阳性或 TST 阳性但＜10mm 的 T-SPOT 阳性。启动 LTBI 治疗，并随访至 2010 年 8 月。
TST 和 T-SPOT 的阳性率分别为 33.6%（280 例中的 94 例）和 69.1%（269 例中的 186 例）。281 例患者中有 35.9%（101 例）开始 LTBI 治疗，281 例患者中有 2.1%（6 例）发展为活动性结核病。在 6 例 TB 患者中，3 例基线时 TST 阴性，未接受 LTBI 治疗，而在基线时进行 T-SPOT 的 4 例患者均显示阳性结果。
在结核病高发国家，TST 定义的 LTBI 诊断和治疗似乎不足以预防抗 TNF 治疗前 TB 的发生。需要进一步研究 T-SPOT 单独或 TST 和 T-SPOT 联合（任一阳性检测策略）用于 LTBI 的检测。
